Health care organizations are challenged to balance financial pressures with the need to provide high-quality, affordable, and accessible health care.
Providers must navigate a rapidly changing environment in order to remain competitive while improving the quality of care and reducing costs.
The healthcare industry is at an inflection point; A new generation of technology and services that will transform how we think about and manage our long-term health needs. Technology can be used for more than just symptom management; it can also help people live healthier lives through prevention, better communication with their providers, and improved self-management skills.
In this session, we’ll discuss how providers can move from fee-for-service to value-based payment models by using technology as a driver for better outcomes and improved population health management (PHM). We’ll also share some of our own innovative approaches including value-based reimbursement programs which have proven successful in helping providers improve patient engagement while lowering cost per case.
[00:00] Pre-Intro dialogue from Michelle Copenhaver
[03:02] Tell us a little bit about your background?
[05:01] What is the importance of strategic partnerships in the healthcare industry?
[07:15] Is there one partnership you've been able to coordinate that you're personally very proud of?
[08:21] One of your passions is helping healthcare providers transition their services from fee for service to fee for value. Tell us a little bit more about what that means?
[11:44] Does it take more time and effort to close a project using fee-for-value billing? Why or why not?
[13:31] What are your thoughts on how artificial intelligence can be used to help fuel this change in the medical industry?
[15:56] You've touched on the social determinants of health earlier. Briefly go over its meaning and the importance, how we understand holistic care relative to the social determinants of health?
[18:29] Have you had a personal experience that you've worked with a staff member who was diagnosed with the social determinants of health?
[20:03] Do you feel like there is enough training for healthcare professionals on how to handle patients who suffer from social determinants of health?
[21:07] How does having less income than someone else affect your ability to access care in the medical field?
[22:32] What's the importance of care coordination, nowadays in healthcare? And then what could healthcare companies do better to improve this coordination?
[27:38] Why do you think patients, families, clinicians, and other stakeholders struggle with maintaining the continuity of communication when transferring across disciplines in a healthcare setting? Or the system is not in place or people just don't care?
[31:18] If a client wants advice on how to sustain a healthy lifestyle, what advice would you share with them?
[34:27] Do you have anything else that you would like to share?
Michelle Copenhaver has a 360-degree view of the health care industry as an experienced executive with 30+ years of experience. She began in clinical settings and transitioned into healthcare administration, where she gained valuable insight from senior leadership roles at various payer companies. This has given her a deep understanding of how to deliver high-quality, cost-effective care that is coordinated across all levels of our health system.
She is driven by my mission to improve the overall health and wellbeing of everyone in this country through innovative thinking, disruptive innovation, and collaboration.
Learn more about Michelle: https://www.linkedin.com/in/michelle-copenhaver-9a245114/
The vast majority of dollars, healthcare dollars are still flowing through fee for service contracts, meaning providers are incentivized or paid for the number of services. Utilization value-based care models are payments based on quality, efficiency, and meaning more efficient and medical cost management, and also on patient satisfaction. The triple aim that many folks talk about. It's around population health models, where you're looking at trends in data, and coming up with ways to close gaps in care. It also means considering social determinants of health, that may be barriers. It's incentivizing providers to be able to spend more time, which is very much against a fee for service model where providers are very strained to see a large number of high volume of patients in a day. So, they're very kind of agnostic. They're not, they're not complimentary approaches. And so, our providers today are having to have one foot in each, or so it would be really great if we could make the shift a little faster. So, folks say, why, isn't this happening faster? Well, there are lots of reasons.Hanh:
Michelle Copenhaver is with me today on Boomer Living. She has over 30 years of experience in healthcare industry is a clinical nurse, healthcare executive, and consultant who has provided 360 degree view of the industry with expertise in all facets, from clinics to payers. With a background as a registered nurse to healthcare administration to business transformation. She is an advocate for quality care, patient safety, and increasing access to high quality affordable health coverage for all Americans. So, I'm excited today to learn from her wealth of knowledge. So, Michelle, thank you so much for joining me today on the podcast.Michelle:
Thank you so much. And I really look forward to talking with you. I've enjoyed listening to your other podcast and I can see the passion that you also have, around seniors and healthcare in general. So, thank you so much.Hanh:
Thank you. So, since beginning of your career, as a registered nurse, you've learned a lot about the healthcare industry in different roles. So, can you tell us a little bit about your background?Michelle:
Yes, I'd be happy to. So, I started at age 19 as a registered nurse, and that was a really pivotal point in my life, because as you can imagine, I worked in a variety of fields. I worked in the operating room. I worked in pediatrics. I worked in dialysis nursing. I worked in clinical research. So, I really got to see a lot of different types of patients and spend time with them and their families. And it really see firsthand some of the navigation challenges that we have in healthcare. As I moved from clinical to research and then to, healthcare administration. Even though I don't practice today as a registered nurse that has always stuck with me and helped me to keep the patient in the middle, always the middle of any kind of strategic planning, business planning, partnership, development, relationships. We always have to remember that the patient is why we are in the healthcare industry. And if it doesn't check that box around, does it make the life of a patient and their family better? Then we may need to revisit the vision, mission, and strategy that we're developing. So, that's been really great. And it's helped me to be able to talk to physicians health systems, hospitals, and other partners. And now that I'm in healthcare technology, it is a really great experience because I can think about, okay, this is technology, this is digital. And now patients, we were patients as well are also consumers. And as everyone knows, we are living with digital and technology every day. And so, how can we optimize technology to make real life clinical situations much much better.Hanh:
Great. Yeah, I concur with that. So, it sounds like, um, your wealth of experience in the healthcare industry helped you in your current role as the VP of Strategic Partnership, at Forcura. So now, what is the importance of strategic partnerships in healthcare industry?Michelle:
It's absolutely essential. So, I think that, the healthcare industry is one of the most complicated industries out there. And it's because it's not only business and technology and digital, but it's healthcare, which is the most personal aspect of anyone's life. So, when you're combining the emotional and physical elements of a life with business it becomes just because of that, I'm very complicated. And so, if any of us thinks that we can address these issues that are monumental, on a daily basis by ourselves, then we're kidding ourselves. We need partners. We need like-minded companies with similar cultures that are focused on the patient that respect and appreciate complimentary approaches that we can co-develop. And so, I think it's very exciting actually, to be with another partner or another company who has a similar interest. And if we're keeping the patient in the middle and we're asking the question, how can we bring our synergistic solutions together to make this better than what I could do alone, better than what you could do alone. How can we positively impact things like transitions in care? How can we, how clinicians who are so over burdened, administratively focuse more on patients? That's what they went to school for. That's what they want to do. They didn't want to be pushing buttons and pushing paper and trying to locate things, you know they need smoother access to documentation. And in this day of more and more fragmented care, which has partly resulted because of good things, because of the fact that there are more and more ways to get health care than ever before, through televideo, more places, sites of service than ever before, which is great, but it also can cause more fragmentation. So, it's on us in the tech industry to create solutions for interoperability. And for exchanging information more real-time, and in a smoother and easier way for our clinicians that we're depending on every day.Hanh:
Absolutely. Yeah. So, is there one partnership you've been able to coordinate that you're personally very proud of?Michelle:
Well, we have quite a few partnerships today through my current role, and they're all important for different reasons, which is another exciting part of my job. So, any partnership or cooperation, each one's unique. Because every company has a little bit, different view or different way of addressing issues in the healthcare industry. So if you can really talk to a partner and become very familiar with their capabilities as compared to yours, and you come up with something very unique with each situation. So, I wouldn't pick a favorite. I think they each bring something really important to the table in servicing our mutual clients. And so, again, it's really, how can we work together to make it easier on our clients, which happened to be providers? So, that then the patient has benefited from a physician who knows much more, has a much more holistic picture of the patient because they have access to data and documentation in a much more efficient way than they did before.Hanh:
Now, I understand that one of your passions is helping healthcare providers transition their services from fee for service to fee for value. So, can you tell us a little bit more what that means?Michelle:
Yeah, absolutely. So, I have been doing work around value-based care since 2010, when the affordable care act came into being, and it has really evolved in the past decade. In some ways it's maybe not as evolved as some of us would like for it to be. And the way I say that is that the vast majority of dollars, healthcare dollars are still flowing through fee for service contracts, meaning providers are incentivized or paid for the number of services. Utilization value-based care models are payments based on quality, efficiency, and meaning more efficient and medical cost management, and also on patient satisfaction. The triple aim that many folks talk about. It's around population health models, where you're looking at trends in data, and coming up with ways to close gaps in care. It also means considering social determinants of health, that may be barriers. It's incentivizing providers to be able to spend more time, which is very much against a fee for service model where providers are very strained to see a large number of high volume of patients in a day. So, they're very kind of agnostic. They're not, they're not complimentary approaches. And so, our providers today are having to have one foot in each, or so it would be really great if we could make the shift a little faster. So, folks say, why, isn't this happening faster? Well, there are lots of reasons. So now, I'll flip to more optimistic view. We. Have made a lot of strides as compared to 10 years ago, despite feeling like sometimes we're not moving quickly enough. A lot has been done in Medicare programs. CMS has launched through CMMI programs a number of Medicare based episodic based and ancillary type provider programs that are moving along. So, we have made a great deal of progress. I have worked with ACO's. I've worked with patients in our medical homes. I've worked with bundle payment providers and some of them are doing amazing work and we're making great strides. But as an industry, we need to do more to support these providers and help them to move in a more intentional way so that they're not still having to think about fee for service at the same time. And this is just going to take more and more effort to always revisit the existing models so that we can improve upon those. And a key to improving upon them is to continue to listen to the providers who are doing this work on a daily basis and involving patients more and engaging them in their own healthcare. So, that's a great deal that we have to do, even though we have come a long way in some respects, but population health efforts need to continue. We need to continue that focus on the quality of care over utilization of care. Not that our health cares, aren't concerned with quality, they are, but just due to the payment models that we have today, the incentives are shaped around utilization in a higher way.Hanh:
Now, does it take more time and effort to close a project using fee for value billing? I guess, why or why not?Michelle:
Yeah, absolutely. Because the whole idea behind quality is that you are looking at the patient holistically and you can't do that in a 10 or 15 minute office visit. So, it requires a much more, holistic approach around multidisciplinary care teams. It's really thinking about the entire practice and having to evolve and think of our roles and responsibilities. How can we have everyone in the office working at the top of their licenses? How can we free up the physician to focus more on the clinical? How can we optimize services of advanced practice providers? How can we incorporate and spend time understanding social determinants? Does this person have food in the refrigerator? Does this person have transportation? Are there caregiver issues? Does this patient even have a home? What kind of support do they receive? Are they having domestic violence issues at home? All that takes time to learn. And when you are incentivized in seeing a large volume of patients per day, you simply do not have time to dig into all those elements that are very likely impacting a physician's health in a very big way. And so, until those things are addressed, we really can't expect patients to be adherent. If they don't have a car to get to the store or if they have to choose between a medication and food for their children, or if they have to choose between being able to go to certain providers versus others. So, I think that until we reshaped that whole model and providers are supported in this effort and incentivized that way it's going to be difficult. But that's what we need for public health and for individualized health, within a population health realm.Hanh:
Absolutely. So, now what's your thoughts on how artificial intelligence can be used to help fuel this change in the medical industry?Michelle:
Yeah. And so, absolutely. Our system and capabilities incorporate artificial Intelligence. I think people are sometimes bristle when they hear that about healthcare. I think, for good reason folks are worried about security, private protected health information, and things like that. Anytime you have an advanced technology like AI coming into the topic, but I think it's a wonderful thing, if it's used well. If it can help with predictive analytics. If it can help with diagnostic processes and clinical decision-making then why wouldn't we want to use it if it's designed well. It can create many efficiencies and workflows. It can help go ahead and target patients for physicians so they can more proactively outreach to those patients. There are just so many uses for both administrative and clinical decision-making aspects that I think it's definitely a very good thing. And it's, it just like anything with technology it needs to be well-managed.Hanh:
I think, um, technology is going to be a huge component in the recovery post COVID and there's been, if you have seen exponential growth in all regards, especially healthcare.Michelle:
Yeah, absolutely. Of course, tele-health and after using it a couple of times, myself, And why would you not want to use it? It's very convenient. It's not going to replace all types of office visits. Certainly in-between those important periodic office visits. It can be very useful for simpler issues and medical issues and touch points with physicians. I think for behavioral health, it could be a tremendous help. I think we are experiencing almost a mental health crisis in this country, right now, due to the pandemic it was here already, in my view. But I think the pandemic exposed that and perhaps accelerated that amongst many individuals. And having a place maybe at home where you can talk to someone in private might encourage some who may have been hesitant before to seek out medical, mental health services. So, I think it's wonderful in that regard, as well. And I think that post pandemic, I don't think it's going away. Perhaps it would be just a complimentary or something that will, some will continue to use, of course, as well, not just, not just...Hanh:
I know you've touched on the social determinants of health earlier, but I wanted to maybe go in a little bit more. So, it's a phrase that we've been hearing more and more in the healthcare industry. So, can you briefly go over its meaning and the importance, how we understand holistic care relative to the, um, social determinants of health?Michelle:
Yes. The Kaiser foundation did a study a few years ago and it's been supported through the literature, very similar statistics where our healthcare is impacted only 10% by actual healthcare services which is a big kind of a startling figure. But it also makes sense. So, if you think about coming in for an appointment with your physician a couple of times a year, and how much time that actually is. It's a very low amount of time. So, 30% of our health is made up of genetic factors and another 60% as a combination of lifestyle choices and socioeconomic factors in our lives. So, our zip code, the lifestyle choices we've made that some of those that we can change if we, if you want to around diet and exercise. I don't know why it's such a surprise to those of us in healthcare to talking about this. Again, if you don't have support at home, if you don't have or if you're in an abusive situation at home, or if you, have to, if you don't have clothes, to go for a job interview, or you know some of these things that most of us take for granted on a daily basis. If these basic things in life aren't present, then I'm not sure how any of us expect patients to follow through on care plans. Those basic human needs need to be taken care of. And some of them are logistical transportation and certainly in our senior population, mobility is a huge factor. Social isolation has really been a concern for our senior population, this past year for all ages. But particularly I think for seniors who may also have mobility or transportation issues and may have access to technology issues as well, that makes them even more isolated. So, I think all of those factors. One thing I'm really encouraged by is the increase in home health services, which puts a clinician in a patient's home, or some of those things can be more readily recognized. And so, I think that is a great opportunity for providers to be able to recognize and capture that information and then connect those patients to community organizations or family members or others where those issues can be hopefully addressed in a better way.Hanh:
So now, have you had personal experience that you've worked with a staff member who was diagnosed with social determinant of health?Michelle:
Well, I think as a nursing professional and just being in the industry, we're always hearing about patients who have these challenges. It's actually, and I think that it's more common than we realize. And I think that while it is worker and perhaps in areas of poverty, it is not just a poverty situation. Again, it can be anything around domestic violence, for example. It can be anybody, unfortunately experiencing that. Or someone losing a job, which we've seen a lot of. That can affect just about anyone. And I think that sometimes people are surprised to learn that those people are in your neighborhood. But I think that now that we're seeing the role of the social worker and pharmacist, even their roles have been elevated in recent years. And we're able to learn a little bit more about those conditions in patients. I think our challenge has been to connect those patients with those community organizations who may be able to help and then the follow through to make sure that those services actually happened and to make sure that the primary care physician gets the feedback on that and closes that loop. So again, it really does come down to communication, care coordination, transitions in care. Those elements are absolutely essential. So, that clinicians are aware of what's going on with their patients and know that they're getting the care that they need, not just healthcare, but these other types of care that we've talked about.Hanh:
So, do you feel like there is enough training for healthcare professionals on how to handle patients who suffer from social determinants of health?Michelle:
I think that it's getting better. And of course, when you think about all the training that physicians go through. We expect a lot, don't we? Start medical school in their early twenties and get out in their mid thirties. They get a lot of training, but I think that I think that it's increasing because we are recognizing it. So, I think that population health, which never would have been in medical school discussions, I think just even just a few years ago, we're now seeing that incorporated into medical schools and training. And I think social determinants will naturally come up with some of the population health training that our physicians are receiving. And of course it can't just be limited to the physician. It needs to be at all levels of care in all types of care, including advanced practice providers, pharmacists, social workers, nurses, anyone who has access to patients really should have some sort of training so that they don't have the answers, they at least know how and where to direct patients that need this care.Hanh:
So, how does having less income than someone else affect your ability to access care in the medical field?Michelle:
It impacts everything, It impacts access to healthy foods, right? It's much more doable to get a dollar meal, right? At fast food than it is to get organic green leafy vegetables that are recommended in a Mediterranean diet. It impacts access to affordable health plans. And so, maybe they have Medicaid. Maybe they don't. If they do have insurance, maybe they have a high deductible plan and they don't have the money to, pay the deductible. And so, they delayed care, right? It has to do with access to certain specialist care, maybe to going to a higher priced or different types of facilities who have higher levels of technology. So, I think that there, the list is pretty long as to why that is an issue. It also is an issue of education and knowing what is even out there for them to choose and having those connections with people. The list is large, as to why that's an issue. And of course we can all read stories about folks who've overcome that. And that's wonderful, but I think that it's on all of us in healthcare to do our part to help those who are disadvantaged.Hanh:
I know you've touched on this earlier. So, I want to add maybe a little bit more, some more questions. What's the importance of care coordination, nowadays in healthcare? And then what could healthcare companies do better to improve this coordination?Michelle:
Yeah. There's a great deal that could be done there. And it's very hard work, which is why it's not more advanced that it is today. So, a transition of care is one of the most vulnerable points in a healthcare journey for a patient. And so, if you think about an elderly patient, for example this could literally happen within a few weeks where you have perhaps an acute admission to the hospital. A discharge occurs a transfer to a skilled nursing facility or a long-term acute care hospital. There are new medications perhaps being added to the regimen. Maybe physical therapy was started. There are lab works, there are radiology procedures. A patient may be referred to a couple of specialists physicians. Perhaps on his or her own, the patient decided to go to a retail center for something along healthcare. Maybe they went to an urgent care. Um, Maybe they're discharged to home, and they're having clinicians come in. So, if you think about that scenario, that can literally happen and it does happen to a single patient. And if you think about all the clinicians and people who touch that patient, how well likely do we think it is that every clinician that touched that patient knew the activity of all the other clinicians that patient interacted with over the last several weeks. And it's probably very unlikely. And if you think of the implications of that for a patient who is sitting before, one of the, one of those providers at any given time, and they're reviewing a medication history and they're reviewing the medications that the patient is on, and they're talking about all the things that happen and they're making clinical decisions real time based on what they do or do not have. That's a pretty serious implication that we're talking about. And so, technology is very important that we continue on this path of interoperability using platforms that are easier, faster, smoother, cleaner, simpler to use where more patient information is available to each clinician along that path, along that continuum of care. So, having that information that they can make more well-informed decisions. And of course patients, there's a lot in technology right now that we're trying our best in technology to have it so that patients have their medical record with them. That if they can take it with them, which would help a great deal. And so, if they could take that with them and show each clinician and make sure that they were aware. But that alone is also a lot for a patient to manage. And, those of us in healthcare know that there's a lot of jargon. There's a lot of things to understand in healthcare. And those of us who are experts in healthcare have meetings every day where we're explaining things to ourselves, Because it's a very complicated industry. And so, for someone to fully understand all that, anybody, any of us is also a big task. And then if you get into the pricing, Wow. We would have to talk for, Hanh, for another couple hours on that one. Because pricing is very confusing in healthcare. And for someone to understand what they're paying, at any given point, if you try to make sense of it based on charges versus your health plan versus the copay versus what someone else is paying, it's a very complicated industry. We have a great deal of opportunity to educate ourselves and the public on what all this means. And we have a great deal, which by the way, I see this as a huge opportunity, right? It's a huge opportunity for a lot of cool and innovative things to happen over the next months and years around technology so that we can improve these things. So, the technology is good. Remote patient monitoring can help with transitions of care, so that information about the patient is going to the physician in between visits. All that's really great. We just have to make sure as we're increasing access, we're also increasing care coordination efforts, so that information is readily available, to those clinicians.Hanh:
It's a big animal,Michelle:
that we're talking about, yeah. It's good to put it out in the forefront because I think too often people stay within their silo or within their scope and not understanding the size of this giant and that we have to remove those silos. It has to be crossing the lines. It's a very coordinated effort.Michelle:
Absolutely. And the more we put it out there. I like how you said that. The more we put it out there authentically, then the more opportunity to be creative and innovative and take those issues that we're all concerned about and come up with exciting improvements that can benefit patients, families, providers, all of us.Hanh:
And that's why we connected because I've always known that it was a huge giant and it just needed to be amplified, so people understand it more and take it on. Now, I know you've touched on this, um, but I just want to folks who understand, why the struggle? So why do you think patients, families, clinicians, and other stakeholders struggle with maintaining the continuity of communication when transferring across disciplines in healthcare setting? It seems like there's so many key stakeholders and we're all diverted. And you touched on a few of the complexities. Do you think, is it a fear of technology or maybe not enough technologies that exist right now to help that coordination? Or the system is not in place or people just don't care? What's your thought?Michelle:
The answers, in healthcare. It's not one answer, right? There are several answers. Fear can certainly be a factor. Sometimes change and having to adopt new technologies is fearful and something that I think does hold back, folks sometimes for sure. I think it's cost. These things are not inexpensive to have them newly updated technology and systems in physician offices and healthcare systems. It's a huge investment of money and time and resources, to do that. And I also think that there are so many disparate systems in use that having them all talk to each other is not a reality, yet, although great strides have been made. But when you think about all the types of providers and how all of them have different types of systems where they're entering important patient information, it would be a huge assumption to say that physician office electronic health record, for example, is talking to the one at the hospital that's also talking to the one at the physical therapy practice that's also talking to the one at the pharmacist. And could have been great strides, but there is still a very long way to go in connecting them so that the pharmacist who is helping the patient with medication reconciliation, medication management, is entering something in the system. And for the physician, the PCP to know that happened. That is a big deal. It is a lot of work and it's progressing, but as you can imagine, it takes time. Now, there are regulations around fire standards and things like that that are going to make people hopefully feel a little less fearful about all this information sharing that really does need to happen so that we have a total picture of the patient at the time of care. But of course there's fear around protecting that information, very sensitive than information about our health, being leaked out. And of course it doesn't help that every week we hear about a new cyber activity that's occurred. So, all these things make it so that we have to be very thoughtful and careful about how we roll these things out, but it does need to happen so that we can talk to each other not only face to face, which cannot be replaced, but also in a way that is much more automaticed, so that anyone touching a patient's care can know what the other clinician has recommended. What does that plan of care? Does the patient have an advanced directive? What are the medications that they're on today compared to what they were on last month and why were they changed? And does the patient have access to his or her own plan of care? So, all those things are very complicated. Technology is really helping, but we also still have a little ways to go.Hanh:
Well, all hats to the folks in the healthcare industry. It's a huge task to take on. And I know it's worth it. And with the last year and a quarter or so, it's shown, right? How strong all these folks are, and just, so, it's amazing.Michelle:
It is amazing, yeah.Hanh:
Now, if a client wants advice on how to sustain a healthy lifestyle, what advice would you share with them?Michelle:
Wow, where to start? I think the first place to start is our own outwork and valuing yourself as someone who deserves attention to your health. So, I think that so many of us are busy, right? Parents, we're taking care of others. We're working jobs that we forget to say, oh, I'm important as well. And so, my health is actually, all I've got for myself, right? So, I think that we have to prioritize and recognize that we deserve some self health care and prioritize physical exercise, which doesn't mean you have to run a marathon. It can just be committing to regular walks or committing to something else that's enjoyable where we're moving. It's acknowledging the fact that what we put inside our bodies is very important. It is prioritizing and modeling that for our families. So, that's important. And then I think it's very important to have a primary care physician with whom you have a good relationship, and with whom you are in touch with, as needed and as appropriate, because that primary care physician can help you stay on top of preventive services that are so important. Screenings, closing gaps in care, getting regular blood work, making sure that the things that you're trying to do to improve your health are taking you in the direction that you want to go. So, that PCP relationship is very important. So, I think that we own it to some degree, ourselves. I think we also then need to have the right clinician relationships. And I think we need to ask a lot of questions. And there's nothing wrong with getting second opinions if we're just not so sure about what we're hearing. So, I think that we do need to seek help when we need it. I think that we need to remember that behavioral health is a part of our health, and we need therapy sessions. If we need, help in that regard. If we need meditation. If we need fresh air to go outside and spend some quiet time, that is all health care. And I think that we need to remember that is a holistic approach, spiritually, behaviorally emotional, physical. It's all our health and it's all important. And we need to listen to ourselves and lean to listen to the signals that our bodies are telling us.Hanh:
I love it. I love that. You said that because although I ask these questions, I have some thoughts in my mind and when you just first said yourself, you've got to own it. You've got to value yourself because here's the thing. A lot of them. A lot of the challenges and a lot of things that we are supposed to do for what's right. Let me tell you. If we don't value ourselves, it's a huge effort to take those on. And if we don't see ourselves as someone that's worth it, who will? If you don't do it for yourself, who will? So, I love it. No, I appreciate that message. I echo that. So, I love it. Do you have anything else that you would like to share?Michelle:
Just, uh, another big, thank you all so much enjoy chatting with you today. I really have appreciated it. And it's fun to talk about things that you really care about. And, maybe one thing that was said that might resonate with someone to help them get on their path to better health.Hanh:
Yeah, I agree. I agree. Thank you. Thank you so much.Michelle:
Thank you, too.